11 in the ); these include the genes encoding AAF/I ( aggA-D), dispersin ( aap), and the dispersin translocator ( aatPABCD). With the exception of stxAB2, genes characteristic of enterohemorrhagic E. Coli are not present in the C227-11 genome. Together, these observations provide support for classifying the outbreak strain as an enteroaggregative E. Among the virulence factors of the German outbreak strain that are common in enteroaggregative E. Coli and other diarrheagenic E.

However, the enteroaggregative E. Coli strains of O104:H4 serotype (orange) form a distinct clade, with highly conserved core genomes (with one O104:H4 isolate, C35-10, being an outlier). The genetic similarity between the Shiga-toxin–encoding strains isolated in the German outbreak and numerous enteroaggregative E. Coli O104:H4 strains lacking the Shiga-toxin–encoding phage suggests that acquisition of the phage was a relatively recent event (Fig.


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